Canada Immigration Assessment

Preliminary Assessment Questionnaire
For Permanent Residency Application /
Temporary Residency Application

Applicant's First Name (required)

Applicant's Middle Name

Applicant's Last Name (required)

Any other Name used previously

Date of Birth

Place of Birth (Place, Country)

Full Mailing Address

Residential Address (if different)

Home Phone Number With Country and Area Code

Cell Phone Number With Country and Area Code

Skype Id

Email (required)

Other Email (If Applicable)

Gender
MaleFemaleOthers

Martial Status (required)

Marriage Date

Nationality

Referred by

Principal Applicant: Please mention all your academic activities starting with most
recent graduation.

Principal Applicant: Please mention all your experience you have gained after your
graduation.

Principal Applicant: IELTS Result (General Module)

Language Test:
CELPIPIELTS

Given IELTS? Yes / No

Reading

Writing

Speaking

Listening

Overall Band

Test Pass Date

Ability in English and French

Reading
HighModerateBasicNot At All

Writing
HighModerateBasicNot At All

Speaking
HighModerateBasicNot At All

Listening
HighModerateBasicNot At All

Reading
HighModerateBasicNot At All

Writing
HighModerateBasicNot At All

Speaking
HighModerateBasicNot At All

Listening
HighModerateBasicNot At All

Spouse Information

Spouse First Name

Spouse Middle Name

Spouse Last Name

Any other Name used previously

Date of Birth

Place of Birth (Place, Country)

Full Mailing Address if different than Applicant's

Number of Children

Cell Number with Country and Area Code

Full Name(First Name, Last Name)

Email

Nationality

Gender

Children Infornmation

Spouse : Please mention all your academic activities starting with most recent
graduation.

Spouse : Please mention all your experience you have gained after your graduation.

Spouse: IELTS Result (General Module) - if available

Reading

Writing

Speaking

Listening

Overall Band

Test Pass Date

Do you or your spouse have applied / Refuse for Canada or any other Country? i.e. PR
Application, Student, Visitor, Work Permit, etc.
(Write Yes/No with full details below)

Yes/No - if yes give details.

Do you or your spouse currently living in Canada? If yes, please provide detials below.

Full Name of the Applicant Canada

Status in Canada (i.e. Visitor, Worker, Student)

Permit Start Date

Permit Expiry Date

Do you or your spouse have any relatives in Canada? i.e. Parents, Grand Parents,
Brother, sister, nephew, cousin, uncle, aunt. (If yes write full details below)

Travel Information (If you have travel outside of your origin country please write full
details below)

* I understand that my first meeting with Sharp International Immigration Services (SIIS) includes an initial brief free assessment of my circumstances to see if I qualify for making an application to Canada Immigration. Sharp International Immigration will not accept clients who do not qualify.*I will declare at the beginning of the meeting if I am here to discuss any matters that deal with an existing problem with Canada Immigration, an application that has already been submitted, to go into depth on my personal immigration circumstances, or an application which I intend to prepare and submit on my own, as these are NOT included in SIIS' free assessment, and I agree to pay for the entire consultation at SIIS' current hourly rate. I agree to provide complete and truthful information in the interview.